Background : Globally road traffic injuries are the leading cause of death among young people aged 15-19 years and second leading cause among 5-14 year olds. The UN General Assembly has declared 2011 to 2020 as the "Decade of Action for Road Safety” which seeks to halt the increasing trends in road traffic deaths and injuries worldwide. The starting point for any interventions aimed at achieving the UN declaration especially with regard to young people would be to first know their understanding and behaviour patterns with respect to road safety.

Methods: A school based cross-sectional questionnaire-based study was conducted among 485 high school students in Anaichikuppam area of Villupuram district in Tamil Nadu.

Results: Majority of study population (n=277, 57.1%) were girls and 34.6% of the students were aware of the legal age for driving but 55% were unable to identify even one of the five given mandatory road signs. 98.1% of the children were aware of the risks of drunken driving. Only 33 (20.88%) students were using helmets while riding motorised two-wheelers and 55 (11.34%) school children had been involved in road-related accidents in the past 1 year.

Conclusions: Study revealed poor knowledge of traffic rules and unsafe traffic behaviour among the school children.

Globally, 1.2 million people die and another 20-50 million sustain injuries from road accidents every year. Road accidents are 9th leading cause of deaths and are estimated to become the 5th leading cause of death by 2020 [1]. Globally road traffic injuries are the leading cause of death among young peopleaged 15-19 years and second leading cause among 5-14 year olds [2]. 90% of world's road traffic fatalities occur in developing countries. It is in this background that the UN General Assembly has declared 2011 to 2020 as the "Decade of Action for Road Safety” which seeks to halt the increasing trends in road traffic deaths and injuries worldwide [3]. India has the dubious distinction of the country with the highest number of road accident fatalities [4]. Pondicherry Institute of Medical Sciences which is situated on the border of Puducherry and Tamil Nadu state caters to populations from either side of the border. Puducherry has the second highest number of road accidents after Delhi among the union territories while Tamil Nadu accounts for 14.5% of total road accident cases in the country [5].

Bringing about behavioural change among young adults with regard to road safety starting from their schooling years would go a long way in bringing down morbidity and mortality due to road accidents.Literature search revealed very few studies conducted, especially from India in the area of road safety among school children. The starting point for any intervention aiming to bring about a greater sense of responsibility and safety among the precious but restless young generation would be to first know about their current level of knowledge and behaviour regarding road safety and build on it, hence this study was undertaken to assess the knowledge and behaviour regarding road safety, traffic rules and risk factors associated with road accidents among high school students. Based on the results of the study, behavioural change communication programmes on road safety will be considered.

Methods

The present study is a cross-sectional study conducted in the field practice area of rural health centre of Pondicherry Institute of Medical Sciences. The health centre caters to rural communities of Anaichikuppam area in Villupuram district of Tamil Nadu. The study was conducted from November 2010 to January 2011.The study covered high school students from all four high schools in the field practice area, which included two government and two private schools. The total number of high school students enrolled in the four schools was 541 out of which students who were present and willing to participate were 485 (89.64%). After getting necessary permissions from the school authorities, these students were interviewed using a predesigned pre-tested questionnaire.

The questionnaire included questions on demographic characteristics, traffic behaviour, risk factors associated with road accidents and traffic rules. With regard to traffic lights, the students were asked to explain the significance of the red, yellow and green lights, responses were considered correct if they implied red was stop, yellow was wait and green was go. The questionnaire also included pictures of 5 road signs (school zone, no parking, 50 kilometers speed limit, no entry and no overtaking) from the group of mandatory road signs, which the students were asked to identify. Data was entered and analysed using SPSS version 16.0. To compare between proportions, Chi-square test was used and p < 0.05 was considered statistically significant. Subsequently road safety awareness programme was conducted in all the schools incorporating the findings of the study.

Results

The mean age of the study population was 14.07 ± 1.042 (range 12-18) years. Majority of the respondents, 277(57.1%) were girls. Table 1 outlines the knowledge regarding traffic rules and the awareness about risk factors. Boys had significantly better knowledge than girls in most aspects. Nearly half of the students (n=236, 48.45%) were able to explain all three traffic lights correctly.

None of the students were able to identify correctly all five traffic signs while only 7 (1.44%) of the students could identify 4 of the signs correctly with boys doing better than the girls (table 2). 46 (58.97%) students from private schools, were able to identify at least one of the traffic signs correctly as compared to 172 (42.26%) government school students and the findings were statistically significant (table 2).

When asked about their driving behaviour, 383 (78.96%) students said that they were using bicycles but none of the tudents wore a helmet. 158 (32.57%) students had ridden motorised two-wheelers while only four among them had valid license. Only 33 (20.88%) of the students used helmets while riding motorised two-wheelers. Five students had even driven a four-wheeler though they were ineligible. It was also revealed that 55 (11.34%) school children had been involved in roadrelated accidents in the past one year.

With regard to the source of information regarding road safety, the schools (n=369, 76%) played major role in making students aware followed by family members (n=47, 9.69%), textbooks (n=38, 7.83%), television (n=3, 6.39%) and newsprint (n=9,1.85%); while 66 (13.6%) students gave no response.

Discussion

The present study revealed 34% of the students were aware of the legal age for driving geared vehicles compared to 53.1 % reported from Chandigarh [6]. In the same study knowledge regarding traffic lights among the students was 59%, while the present study revealed a knowledge level of 48.4%. The higher level of awareness regarding legal age for driving and knowledge regarding traffic lights in a Chandigarh study and present study could be due to urban and rural study populations, as urban population has generally higher literacy rate and better exposure to the media.

Boys had better knowledge when compared to girls with respect to risk factors and road signs probably because boys have more exposure to media and the outside world than girls who are confined to homes although overall none of the students could identify all five road signs correctly.

A study conducted in Hyderabad revealed that 70% of the two-wheeler (motorised) riders were not using helmets [7]; in the present study 79% of the students who were driving motorised two-wheelers did not wear helmets. A study from Texas, USA showed that only 13.5% of children were using helmets while riding a bicycle [8]. In the present study the practice of wearing helmet among student cyclists was non-existent as it is not mandatory in this state for cyclists to wear helmets.

The study further revealed that 11% of the students had been involved in road-related accident in thepast 1 year which was comparable to 10.8% amongschool children in China [9]. Overall the study revealed poor knowledge regarding traffic rules and road signs among the school children, whereas knowledge regarding risk factors associated with road accidents was found to be adequate. Mere knowledge does not necessarily translate into improved traffic behaviour as was seen in this study with majority of the students who had driven a motorised two-wheeler did not have a valid license and did not wear a helmet. Improving road safety is a multi-dimensional task requiring efforts and coordination from various stake holders i.e. students, parents, teachers, law enforcement agencies and policy makers through various means. An attempt was made, by following up the study with road safety awareness programmes in the affected schools with a view to bring about attitudinal and behavioural change in the school children.

Key Points

55 % of the students were unable to identify even one of the five given mandatory road signs.

Overall the study revealed poor knowledge regarding traffic rules and road signs among the school children, whereas students had good knowledge regarding risk factors associated with road accidents.

Mere knowledge does not necessarily translate into improved traffic behaviour as was seen in this study with majority of the students who had driven a motorised twowheeler did not have a valid license and did not wear a helmet.

World Health Organization. World report on child injury prevention. Geneva (CH): WHO press (CH); 2008 [cited on 2010 November 26]. Table 1.1, Leading causes of death in children, both sexes, world 2004. http://www.whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf Accessed on November 26, 2010.

Dash D K, India leads world in road deaths: WHO. The Times of India.2009 August 17. http://articles.timesofindia.indiatimes.com/2009-08-17/india/281819731roadaccidents road-fatalities-global-roadsafety Accessed on March 7, 2011.